Long-term of epicardial radiofrequency ablation and benefit for recurrent ventricular arrhythmia in Brugada syndrome: A systematic review and meta-analysis

Background: Brugada syndrome (BrS) is a rare cardiac channelopathy linked to an increased risk of ventricular arrhythmias (VA) and sudden cardiac death. Radiofrequency ablation (RFA), particularly epicardial ablation, is recommended for BrS patients with recurrent VA unresponsive to conventional treatments like implantable cardioverter-defibrillators (ICD) and quinidine. This study aims to evaluate the long-term efficacy of epicardial RFA in preventing VA recurrence in BrS. Methods: A systematic search of PubMed, ScienceDirect, Cochrane Library, and ProQuest databases was conducted following PRISMA 2020 guidelines. Studies on RFA for VA in BrS were included. Primary outcomes were VA recurrence and all-cause mortality. Statistical analysis was performed using Review Manager 5.4. Results: Epicardial, endocardial, and combined ablation strategies effectively reduced VA recurrence, decreased ICD shocks, and improved clinical outcomes in BrS. Epicardial ablation RFA near coronary arteries showed a notable reduction in VA recurrence, while endocardial ablation remained a viable alternative. Meta-analysis revealed a significant reduction in VA recurrence (RR 0.17; 95 CI 0.07�0.43; p <.0001) and ICD shocks (RR 0.13; 95 CI 0.04�0.44; p =.001). Subgroup analysis suggested greater VA reduction with epicardial ablation, though without statistical significance. Conclusion: Epicardial RFA is associated with a significant reduction in recurrent VAs (83) and ICD shock rates (87) in patients with BrS. The procedure demonstrates a favorable long-term safety profile, with no mortality reported in the included studies. © 2025 The Author(s). Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.